Political efforts with Imaging.

political efforts for imaging

I read the below article in Aunt Minnie Europe posted 7/7/2026 talking about the need to continue hunting for an answer with imaging through persistence.

99% wasn't enough: How persistence in imaging changes the picture

Two patient stories told at the European Parliament proved that a second look can change everything.

This charged my memory about blogs I was thinking about writing regarding: a book that a woman recently wrote describing how total body MRI saved her life by detecting a small lung nodule, that was subsequently resected and shown to be cancer and she considered this saved her life, and probably she was right. There was a response maybe to this book, or maybe not, by well regarded academic radiologists with MRI expertize who warned of the dire consequences of total body MRI, and this should be considered as total body MRI performed in malls. So they are right also. They focused on expertise, but mainly on the fundamental costs, and primarily the downstream costs and risks of more imaging and interventions conducted for things that were likely incidental. So more harm than good.

So all these conflicting view points all have elements of truth to them.

Actually the first thought I had, is all the patients with GDD from Europe who have contacted me. I am thinking in particular two German GDD sufferers who are extremely knowledgeable about the science. They should reach out to the same European parliamentary group to tell them their story of GDD. In a a dark humor way this European parliamentary hearing would be called. The importance of Non persistence of imaging investigation. This of course is also just telling part of the picture. The best conference would be entitled something like: The wise use of imaging and investigation. Know when to hold 'em, know when to fold 'em.

Here is my brief take:

To start with, I have written from 1993- 2016 six editions of the dominant book in the world on MRI of the abdomen and pelvis. Which also generated spin-off knock-offs. Progressively from the first edition to about edition 3, I focused on common appearances and then progressively added in rare appearances. The problem with rare unique cases, I realized then by the 4th edition, that at some point, a unique case of something suggests anything can look like anything else. By emphasizing rare cases, it then creates the illusion that anything can look like anything, and then the logical next steps, then nothing is of value, and then the final result is descent into anarchy. So I stopped showing unique cases. I focus on appearances that are in the range of 95% of individuals, not 1 in 100,000 appearance of a case, such as liver metastases or hepatocellular cancer

The other innovation I made in the books and papers, is that I made sure to use the most common terms for disease that pathologists used, where the tendency had been to use archaic pathology terms from decades past, and their use made radiologists look like numbskulls.

The bottom line, for anything to be of material value in medicine and everything else, is it has to be evident in an appreciable number of people, and preferrable also with a predictable pattern..

So I am extremely wary of anecdotes and patient's describing their stories... UNLESS ... their story describes a common, repeated pattern of a disease or drug reaction.

So there are a number, many of them radiologists, whoi may think, but Dr Semelka aren't you then arguing against patients with GDD telling their stories, since they are rare... and telling them can ruin everything.

Well 2 points, 1. although very uncommon they are not rare, and the findings are consistent among many sufferers. Probably there are in the neighborhood of 50,000- 100,000 sufferers, and maybe 20,000 of them know that it was a GBCA that caused this. So it is not rare, and more importantly we caused it (remember we are supposed to be thinking Primum Non Nocere). But the critical point that I have tried to emphasize for 10 years, if you do not recognize that GDD has developed in a patient, there is an overwhelming tendency to do repeat GBCA enhanced MRI studies (see the word Persistence of more imaging in the above description of the European Parliament). Each repeat GBCA infection they get, the disease becomes worse, until eventually it is essentially untreatable. People will live a life in intense pain and agony... and we radiologists did it. And it was avoidable. This can be avoided if you understand GDD, and realize after the first development, hopefully after the first GBCA injection, then stopping subjecting the person to GBCAs, the severity of the disease is generally mild, and in many it will largely resolve on its own. So this is a a huge deal.

Most recently I have recognized that knowing a particular topic in medicine is like knowing a language. This pertains well to Europe. So if you know about one topic, like detecting abnormalities on an MRI study, you know one language, if you know about benefits it is a second language, to know about risks is a 3rd language, To know about cost/benefit that is a 4th language. So to really understand a subject well you need to know at least 4 different languages, relatively fluently. When it comes to health care most physician may know 1 or 2 languages, but most fail on the third and fourth languages.

So to really understand a topic in medicine well, you need to speak at least 3 or 4 , but preferably 5 different languages.

So the European parliament was focused on 1 language: individual patients can have in their individual case very difficult detection of a disease process that may require persistent multiple imaging studies or multiple testing. Talking about just persistence of imaging is like speaking Albanian. So yes this can be important in individual cases, BUT to know the subject you need to speak at least 4 different languages fluently, other wise you are living the Tower of Babel story.

Richard Semelka, MD